Medical Policy Updates – Regence

Commercial medical policies – changes effective July 1, 2019

Genetic Testing

• Chromosomal Microarray Analysis (CMA) for the Genetic Evaluation of Patients with Developmental Delay, Intellectual Disability, Autism Spectrum Disorder, or Congenital Anomalies (#58)
  • Changed policy name
  • Added to the medical necessity criteria testing of adults for the same indications as testing of pediatric patients

• Evaluating the Utility of Genetic Panels (#64)
  • Added 13 investigational panels
  • Removed four investigational panels

Laboratory

• Laboratory Tests for Heart and Kidney Transplant Rejection (#51)
  • Changed policy name
  • Added donor-derived cell-free DNA testing for kidney transplant

Medicare advantage medical policies – Changes effective July 1, 2019

Genetic Testing

• Genetic and Molecular Diagnostics – Next Generation Sequencing and Genetic Panel Testing (Medicare #64)
  • Revised row for BDX-XL2 to direct the user to medical policy Genetic and Molecular Diagnostic Testing (Medicare Genetic Testing #20)
  • Revised wording for ColoNext test; the same local coverage determination (LCD) and criteria are used but we clarified how the LCD is to be applied
  • Added new third quarter 2019 codes

Laboratory

• Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer (Medicare #60)
  • LCD L35000 was removed and local coverage article (LCA) A56199 was added to address CPT 81500
  • Added LCD L35396 to the row for ROMA testing performed in certain service areas